MedicaidAdministrativeHigh impact
Newsletter Vol. 20, No. 06
New Jersey Medicaid·NJ · Oncology, Rheumatology, Orthopedics·Provider Notice
Effective date
Mar 1, 2010
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid is implementing immediate auditing procedures for practitioner-administered drugs requiring NDC codes and metric quantities. Providers must allow on-site audits of patient records and drug acquisition documentation, with claim recoupment for unverifiable NDC numbers.
Action Required
Immediately: Ensure all practitioner-administered drug claims include accurate 11-digit NDC numbers and metric quantities matching pharmacy standards for HCPCS codes J0120-J9999, Q0138, Q0139, Q2009, Q3025, Q3026, Q4081, and Q9953-Q9999. Maintain detailed drug acquisition records for audit verification. Prepare for potential on-site audits of patient medical records and be ready to provide drug acquisition documentation for 20 randomly selected claims from the past 6 months. Inaccurate NDC reporting will result in claim recoupment.